Rural versus urban colorectal and lung cancer patients: differences in stage at presentation

Rural surgeons are often uneasy when their outcomes are compared with those of urban surgeons because they perceive that rural patients typically present with worse disease. Rural patients with cancer are commonly thought to present at a later stage of disease, although this is based largely on anecdotal evidence.

Retrospective, descriptive analysis of cancer stage at presentation of rural versus urban patients with two common cancers (lung, colorectal) using the Surveillance, Epidemiology, and End Results database from the National Cancer Institute. Rural versus urban designations were based on rural-urban continuum codes from the US Department of Agriculture. We constructed an ordinal logistic regression model to compare stage at presentation between rural and urban colorectal and lung cancer patients, while controlling for other factors that might be associated with late stage at presentation, including age, race, gender, marital status, income level, and level of education.

In univariate and multivariate analyses, patients with colorectal and lung cancer from rural areas were not more likely to present at later stage. The ordinal logistic regression model indicated that urban patients are more likely to present with late-stage colorectal and lung cancer, compared with rural patients (p < 0.001). For colon cancer, other factors notably associated with stage IV disease were low-income, African-American race, age younger than 65 years, divorce, male gender, and language isolation. For lung cancer, factors notably associated with stage IV disease were African-American race, divorce, male gender, and language isolation.

Urban rather than rural residence appears to be associated with later stages of lung and colorectal cancer at presentation. This finding is contrary to the common assumption that rural patients present at later stages of disease.